A nurse is providing anticipatory guidance to the parents of a toddler. Which of the following should the nurse include? (Select all that apply.)

A. Patent ductus arteriosus, foramen ovale, aortic arch is incorrect because the aortic arch is a normal part of the circulatory system and does not close after birth. A patent ductus arteriosus is abnormal if it remains open after birth.

B. Foramen ovale, ductus arteriosus, coronary sinus is incorrect because the coronary sinus is a normal cardiac structure that collects venous blood from the myocardium into the right atrium; it does not close after birth.

C. Pulmonary artery, ductus venosus, tricuspid valve is incorrect because the pulmonary artery and tricuspid valve are normal heart structures, not fetal shunts. Only the ductus venosus among these closes after birth.

D. Foramen ovale, ductus arteriosus, ductus venosus is correct because these three fetal shunts bypass the lungs and liver: the foramen ovale allows blood to flow from the right atrium to the left atrium, bypassing the lungs; the ductus arteriosus connects the pulmonary artery to the aorta, diverting blood from the lungs; and the ductus venosus shunts oxygenated blood from the umbilical vein directly to the inferior vena cava, bypassing the liver. These structures normally close after birth as the newborn transitions to pulmonary and hepatic circulation.

A. Inspiratory stridor is correct. Stridor is a high-pitched, noisy sound during inspiration caused by partial obstruction of the upper airway, such as laryngeal edema or congenital anomalies. In a newborn, stridor indicates that the infant is struggling to get enough air into the lungs, and immediate assessment is needed to prevent hypoxia.

B. Increased appetite is incorrect. Feeding difficulties, not increased appetite, are more likely in a newborn experiencing respiratory distress. Labored breathing can make sucking and swallowing difficult, which may lead to poor intake or fatigue during feeding.

C. Retractions are correct. Retractions occur when the intercostal muscles, subcostal areas, or suprasternal notch pull inward with inspiration. This reflects increased respiratory effort because the newborn is working harder to expand the lungs against resistance. Retractions are a classic and easily observable sign of respiratory distress.

D. Nasal flaring is correct. Flaring of the nostrils occurs as the infant attempts to increase airflow into the lungs. This is a compensatory mechanism to reduce airway resistance and improve oxygen intake. Nasal flaring is particularly noticeable in newborns because their nasal passages are narrow and easily obstructed.

E. Grunting is correct. Grunting is an expiratory sound made when the newborn partially closes the glottis while exhaling. This helps maintain alveolar pressure and improve gas exchange, which is a compensatory response to lung immaturity or alveolar collapse. Persistent grunting is a red flag for significant respiratory compromise.